Advice for older people and their caregivers by: ​Dr James Bratt.

This is a tricky one, especially when looking after a parent. It may be very uncomfortable to talk or think about, but persons with dementia may experience an increase or decrease in their sexual feelings. It’s a sensitive topic and due to the effect of dementia on the brain, changes in sexual behaviour may be unpredictable. I’ve included some useful advice to help discuss this issue from a brochure ‘Sex and Intimate Relationships’; published by the Alzheimer’s Society UK.If there is an increase in sexual feelings and behaviours or ‘sexual disinhibition’, bear in mind that it may be caused by a few things that you may have not already thought about:

needing to use the toilet

discomfort caused by itchy or tight clothing or feeling too hot

boredom or agitation

expressing a need to be touched, or for affection

misunderstanding other people’s needs or behaviour

mistaking someone for their current (or previous) partner

Caregivers should take a sensitive approach towards turning down sexual demands by persons with dementia to help prevent aggression and maintain the person’s dignity. Try not to make accusations or be offended by their behaviour; instead talk to them calmly and in private to avoid embarrassment.

Another option that I have seen work in the past is to get male caregivers. This is hard to do because most carers are female, and also it may be that you like the ones you already have. Sometimes distracting or redirecting the person is enough. Also, once the female caregiver is aware of the illness, and it's explained to them, they can better approach sexual advances in a more understanding way.

However, sexual disinhibition can become out of control and we may have to resort to medication. Usually we start with SSRI antidepressants which can have the side effect of decreasing libido. If that is ineffective there are stronger meds like antipsychotics, or even anti-androgens (androgens are the male hormones like testosterone).​​

On the other hand, if you have a spouse with dementia, it’s important to know that a decreased interest in sex should not be taken personally. Some persons may be more comfortable with other forms of intimacy and affection instead. It is important to find other ways to feel close to your partner and to reduce your own frustration.

If you are able to continue your sexual relationship with your partner who has dementia, this is great, as long as both parties are:

comfortable in the relationship

not being exploited or being taken advantage of

acting in a way that is in keeping with their values

willing and able to consent to the relationship.

It may be worth talking to a professional about this issue if you are having problems, feeling unappreciated or neglected. Or if you are feeling guilty or uncomfortable regarding your loved one’s sexual needs, or lack thereof. Most times with some consideration, sensitivity and professional input, sexual issues in dementia can be resolved while maintaining the dignity of all parties.

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Dr James Bratt, Lead Consultant at Age Caribbean and Geriatric Psychicatrist.